**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
*This can be a full-time or part-time role*
Position Purpose:
Provides dissatisfied beneficiaries and/or providers/suppliers the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides a denovo independent second level determination based on the documentation, facts, laws, regulations, and guidelines.
Essential Responsibilities:
- Writes, and may plan, a reconsideration decision that is clear and supports the determination made.
- Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, Centers for Medicare & Medicaid Services (CMS) policy, and local Medicare policy, or other authoritative sources.
- Ensures, and may plan, that all appeal issues raised by the beneficiary, representative, and supplier have been addressed.
- Provides a fair and impartial decision.
- Conducts research using online federal regulations, Medicare Administrative Contractor (MAC) policy, standards of medical practice, CMS contractor manuals, coverage issues manuals, and medical literature to complete an accurate and well-supported decision.
Minimum Qualifications
Education
- Doctor or PharmD degree from an accredited school
License and Certification
- Active State license to practice
- Board certification
Experience
- Five (5) to Seven (7) years of clinical or direct patient care
- No federal or state sanctions as would appear on reporting from the National Practitioner Data Bank (NPDB)
- Medicare regulations or review experience, preferred
- Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
Benefits
C2C offers an excellent benefits package, including:
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Competitive salary
- License/credentials reimbursement
- Tuition Reimbursement
EOE Vet/Disability